Stress urinary incontinence in men significantly affects the quality of life. Artificial urinary sphincter (AUS) is the standard treatment for moderate to severe cases. Implantation of the AUS can be done using either the perineal or the penoscrotal approach. These two techniques differ in anatomical access and surgical exposure, leading to ongoing debate regarding their advantages and limitations. This study aimed to quantitatively compare the perioperative and postoperative outcomes of the perineal versus penoscrotal approaches for AUS implantation in men.

A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library. Studies that compared the two surgical techniques and reported outcomes such as cuff size, operative time, dry pad rates, social continence, complications, AUS removal, or revision rates were included.

Six observational studies with a total of five hundred ninety-five patients met the inclusion criteria. The perineal approach was associated with significantly larger cuff sizes (OR = 3.63 [1.94–6.8], P < 0.0001), while the penoscrotal approach was correlated with shorter operative times (MD = 32.98 [19.5–46.46], P < 0.00001). On the other hand, complications, dry rates, and social continence outcomes did not differ significantly between the two techniques.

The perineal and penoscrotal approaches demonstrated comparable efficacy regarding continence, complications, and long-term device functionality. However, the perineal approach favored larger cuff sizes, whereas the penoscrotal method offered decreased operative times and fewer removals. Both approaches are viable, but the surgical technique should be individualized based on patient anatomy, surgeon experience, and patient expectations. However, our results can be limited by the observational nature and small number of included studies.